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Richardson C, Friedman SD, Park JS, Bonilla-Velez J, Dahl JP, Parikh SR, Perkins J, Johnson K. Comparison of Slide Tracheoplasty Technique on Postoperative Anatomic Outcomes in Three-Dimensional Printed Models. Laryngoscope 2021; 132:1306-1312. [PMID: 34606107 DOI: 10.1002/lary.29874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS We hypothesized that the use of three-dimensional (3D) printed tracheal models to reproducibly simulate surgical technique variations in slide tracheoplasty would demonstrate the quantitative impact of surgical variables on postoperative tracheal dimensions. STUDY DESIGN Prospective analysis of three-dimensional printed surgical simulation models. METHODS Slide tracheoplasty was performed on 3D printed long segment tracheal stenosis models with combinations of tracheal transection incision angle (90°, 45° beveled superior to inferior, 45° beveled inferior to superior) and tracheal transection location relative to the stenosis (at midpoint, 2 mm each superior and inferior to midpoint). Postoperative computed tomography (CT) scans measured changes in tracheal length, volume, and cross-sectional area compared to controls. Statistical analysis was performed using one-way analysis of variance and unpaired two-tailed t-tests. RESULTS Slide tracheoplasty yielded 27 reconstructed tracheas. On average, slide tracheoplasty reduced total tracheal length by 36%. Beveled tracheal incisions yielded 9.5% longer final tracheas than straight transection incisions (P < .0001). Cross-sectional area at the stenosis midpoint increased from 9.0 mm2 to 45 mm2 but did not vary with technique (P > .05). Total tracheal luminal volume increased from 900 mm3 to 1378 mm3 overall and was largest with beveled incisions (P = .03). More material was discarded with straight incisions compared to beveled (89 mg vs. 19 mg, P < .0001). CONCLUSIONS Beveled tracheal transection incisions resulted in increased tracheal length, longer anastomotic segments, increased volume, and reduced tissue waste as compared to straight incisions. Offsetting the incision from the midpoint of stenosis did not significantly affect reconstructed tracheal morphology. Using 3D printed models for surgical simulation can be helpful for the quantitative study of the effect isolated surgical variables on technical outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Clare Richardson
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Seth D Friedman
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jason S Park
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Juliana Bonilla-Velez
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A.,Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Sanjay R Parikh
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Jonathan Perkins
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
| | - Kaalan Johnson
- Department of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Washington, District of Columbia, U.S.A
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Zhang H, Wang S, Lu Z, Zhu L, Du X, Wang H, Xu Z. Slide tracheoplasty in 81 children: Improved outcomes with modified surgical technique and optimal surgical age. Medicine (Baltimore) 2017; 96:e8013. [PMID: 28930836 PMCID: PMC5617703 DOI: 10.1097/md.0000000000008013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the surgical outcome of slide tracheoplasty.Eighty-one patients who underwent slide tracheoplasty were retrospectively reviewed. Before and after operation, all patients were examined by computed tomography (CT) and bronchoscopy regularly.There were 8 deaths and the mortality was 9.9%. They all died of respiratory failure associated with the formation of granulation tissue in the airway postoperatively. The mortality was 15.8% from 2009 to 2012 and decreased to 8.1% from 2013 to 2016. The mortality of patients aged 10 to 24 months was 5.7%, which was significantly lower than those younger than 10 months and those older than 24 months. After surgery, 11 patients had granulation tissue growing at anastomosis edges and 8 of them died eventually. Twenty patients had mucosa varus at the site of anastomosis which mainly happened in the early time. Between different time periods and different age groups, there was significant difference in the incidence of granulation tissue and mucosa varus (P < .01). Clinical symptoms of tracheal stenosis disappeared and the results of CT were satisfactory after operation.Slide tracheoplasty is an effective surgical method for congenital tracheal stenosis associated with congenital heart disease. With the continuous improvement of surgical technique, the mortality has been reduced and the incidence of granulation tissue and mucosa varus also has been reduced. The period of 10 to 24 months of age is the optimal cure time.
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Razumovskiĭ AI, Afukov II, Kulaev AD, Alkhasov AB, Mitupov ZB, Kulikova NV, Stepanenko NS. [Sliding traсheal plasty in children under extracorporeal membrane oxygenation (first experience in Russia)]. Khirurgiia (Mosk) 2015:4-13. [PMID: 26356052 DOI: 10.17116/hirurgia201584-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To improve the results of surgical treatment of children with extended tracheal stenosis. MATERIAL AND METHODS Since 2013 slidingtraсheal plasty under extracorporeal membrane oxygenation was performed in 4 children aged 1 year 2 months - 4.5 years with extended tracheal stenosis in Children's City Clinical Hospital №13. Patients' weight was from 10,5 to 16 kg. Extended tracheal stenosis and complete cartilag inousrings were confirmed in all patients after peoperative survey. Indications for surgery were based on medical history data, the severity of respiratory failure and survey data. Sliding traсheal plasty by different approach esunder extracorporeal membrane oxygenation was applied in all patients. RESULTS There were no intraoperative complications. In the study group 1 patient died in remote postoperative period after discharge due to deterioration of his condition caused by upper respiratory tract infection and acute respiratory failure. In immediate postoperative period 1 patient had pronounced growth of granulation tissue in the area of anastomosis followed laser photocoagulation and prolonged intubation. The average ICU-stay was 24 days, the duration of mechanical ventilation - 11 days. Follow-up carefor patients was conducted on terms of 4-6 and 12 months after surgery. In 2 patients moderate complaints of recurrent bronchitis without signs of respiratory insufficiency during 6-8 months postoperatively were observed. In one child complaints were completely absent.
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Affiliation(s)
- A Iu Razumovskiĭ
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - I I Afukov
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - A D Kulaev
- N.F. Filatov Children's Clinical Hospital #13, Moscow
| | - A B Alkhasov
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - Z B Mitupov
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
| | - N V Kulikova
- N.F. Filatov Children's Clinical Hospital #13, Moscow
| | - N S Stepanenko
- Chair of Pediatric Surgery, N.I. Pirogov Russian Research Medical University
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Chung SR, Yang JH, Jun TG, Kim WS, Kim YH, Kang IS, Huh J, Song JY, Cho J. Clinical outcomes of slide tracheoplasty in congenital tracheal stenosis†. Eur J Cardiothorac Surg 2014; 47:537-42; discussion 542. [DOI: 10.1093/ejcts/ezu196] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aaltonen PL, Puntila JT, Suominen PK, Mattila IP, Sairanen HI, Lindahl H, Salminen JT. Resection of the stenotic segment with individually tailored anastomosis for symptomatic congenital tracheal stenosis in infants. Eur J Cardiothorac Surg 2014; 45:e215-9. [PMID: 24682872 DOI: 10.1093/ejcts/ezu113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse retrospectively population-based results of congenital tracheal stenosis (CTS) repair in infants in Finland. METHODS Data on infants who were operated on for CTS in Helsinki Children's Hospital between August 1988 and May 2013 were analysed retrospectively. Fibreoptic bronchoscopy was performed perioperatively and in follow-up of all the surviving patients. The median follow-up time was 7 (range 1-20) years. RESULTS Thirteen infants were operated on for CTS. Resection of the stenotic segment with individually tailored anastomosis was used in 12 patients and slide tracheoplasty in 1 patient. The median age at the operation was 2.9 (range 0.2-19) months. Eight (62%) patients had associated cardiovascular defects, which were corrected during the same operation. The median length of stenosis was 35% (range 25-60%) of the total length of the trachea. The median length of time of postoperative mechanical ventilation was 10 (range 5-19) days. The median length of time of intensive care treatment was 15 (range 7-40) days. One patient died from hypoplastic lung tissue and fibrosis, and multiorgan failure. One patient required reoperation, and 3 other patients received balloon bronchodilatations postoperatively. There was no late mortality. All of the 12 survivors had a good outcome. CONCLUSION Resection with individually tailored anastomosis with up to 55% of the stenotic segment of the trachea presented a good long-term outcome.
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Affiliation(s)
- Panu L Aaltonen
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Juha T Puntila
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Pertti K Suominen
- Department of Paediatric Anaesthesiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Ilkka P Mattila
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Heikki I Sairanen
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Harry Lindahl
- Department of Paediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Jukka T Salminen
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
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Do tracheas grow after slide tracheoplasty? Ann Thorac Surg 2012; 93:1083-6. [PMID: 22381446 DOI: 10.1016/j.athoracsur.2011.12.075] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/25/2011] [Accepted: 12/30/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Slide tracheoplasty has become the surgical technique of choice for repair of congenital tracheal stenosis. Despite the initial reluctance regarding the ability of this "reconstructed" trachea to grow, the reduced morbidity and mortality have allowed slide tracheoplasty to be widely adopted. The aim of this study was to evaluate tracheal growth after slide tracheoplasty. METHODS This was a retrospective study. In follow-up bronchography performed 1, 6, 12, 18, and 24 months after slide tracheoplasty, we measured the cross-sectional areas of the midtrachea and distal trachea at each investigation and correlated the measurements with the anthropomorphic factors (body weight, height, and body surface). RESULTS Fourteen patients were enrolled in this study. The midtracheal and distal tracheal cross-sectional areas significantly increased with time (p ≤ 0.0001). The average rates of midtracheal growth were 21.0 mm(2)year in the first 6 months and 8.0 mm(2)/year in the first 2 years, and the distal trachea grew 18.5 mm(2)/year and 8.4 mm(2)/year, respectively. Regression analysis showed that both the midtrachea and the distal trachea increase significantly with weight (r(2) = 0.257, p ≤ 0.0001), height (r(2) = 0.376, p ≤ 0.0001), and body surface area (r(2) = 0.315, p ≤ 0.0001). Balloon dilation did not significantly alter the tracheal growth in the first 2 years after slide tracheoplasty. CONCLUSIONS Slide tracheoplasty does not inhibit tracheal growth. The reconstructed trachea grows faster in the first 6 months and slows in the following 18 months. There is a positive correlation between tracheal cross-sectional area and weight, height, and body surface area.
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Abstract
PURPOSE Slide tracheoplasty for congenital tracheal stenosis was reported by Tsang. This procedure provides good results, but there are few studies about the tracheal growth of post-surgical condition. Recently, not only traditional posterior to anterior slide plasty but also right side to left side slide plasty was reported. We evaluated the tracheal growth after slide tracheoplasty in growing Japanese white rabbit model. METHODS The Japanese white rabbits, weighing 1,600-2,400 g, were used for this study. One-third of the estimated length of the trachea was slantingly resected about an appropriate angle. We performed a slant, side-to-side tracheal anastomosis in two ways (slanted from the front to the back in four animals, and slanted from right to left in four animals) on growing rabbits as an animal model of slide tracheoplasty. RESULTS All the rabbits were alive until the 10th week after surgery. There was no evidence of differential growth in any part of the circumference of the normal and anastomotic tracheas. Histologically, all tracheal lumina were completely lined with normal respiratory epithelium and normal surrounding cartilage. CONCLUSION The results presented that these two methods did not prevent the tracheal growth and trachea did not buckle macroscopically. Both slide tracheoplasties did not interrupt the growth of trachea.
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Affiliation(s)
- Yoichi Takano
- Department of Pediatric Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan ,Division of Pediatric Surgery, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Kosaku Maeda
- Division of Pediatric Surgery, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
| | - Chieko Hisamatsu
- Department of Pediatric Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Eiji Nishijima
- Department of Pediatric Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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Manning PB, Rutter MJ, Lisec A, Gupta R, Marino BS. One slide fits all: The versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children. J Thorac Cardiovasc Surg 2011; 141:155-61. [DOI: 10.1016/j.jtcvs.2010.08.060] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 08/07/2010] [Accepted: 08/29/2010] [Indexed: 11/15/2022]
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Both epithelial cells and mesenchymal stem cell–derived chondrocytes contribute to the survival of tissue-engineered airway transplants in pigs. J Thorac Cardiovasc Surg 2010; 139:437-43. [DOI: 10.1016/j.jtcvs.2009.10.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 09/14/2009] [Accepted: 10/04/2009] [Indexed: 11/20/2022]
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Terada M, Hotoda K, Toma M, Hirobe S, Kamagata S. Surgical management of congenital tracheal stenosis. Gen Thorac Cardiovasc Surg 2009; 57:175-83. [DOI: 10.1007/s11748-008-0399-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Indexed: 11/28/2022]
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Kim SM, Han SJ, Choi HS, Nam YT, Oh JT, Choi SH. Slide thyrocricotracheoplasty: a novel surgical technique for congenital laryngeal atresia. Pediatr Surg Int 2008; 24:383-6. [PMID: 17522869 DOI: 10.1007/s00383-007-1937-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study was to introduce a new surgical technique for the correction of congenital laryngeal atresia. A female baby had laryngeal atresia at birth and received emergency tracheostomy at another hospital. The baby visited our hospital at 7 months of age for corrective surgery of airway obstruction. We used a new surgical technique for reconstruction of her airway, the slide thyrocricotracheoplasty, which was a modification of slide tracheoplasty and anterior cricoid split. The extubation was successful at the postoperative fifth day, and the baby was discharged on the 33rd day after operation. The serial follow-up bronchoscopy on the fourth and 18th postoperative months revealed good healing and normal growth of tissue at operation site without stenosis and granulation. Slide thyrocricotracheoplasty produced a desirable result and offered the same advantages as slide tracheoplasty. The authors believe that this technique offers an efficient surgical procedure for the single-staged correction of congenital laryngeal atresia.
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Affiliation(s)
- Seong Min Kim
- Division of Pediatric Surgery, Department of Surgery, Yonsei University College of Medicine, Shinchon-dong 134, Seodaemoon-gu, 120-752 Seoul, South Korea
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Brazdil J, Tlaskal T, Vojtovic P, Pohunek P, Cihar M. Slide Plasty of Trachea and Right Main Bronchus in a Newborn. Ann Thorac Surg 2008; 85:1096-7. [DOI: 10.1016/j.athoracsur.2007.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 09/11/2007] [Accepted: 09/17/2007] [Indexed: 10/22/2022]
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Abstract
Long-segment tracheal stenosis in infants and small children is difficult to manage and can be life-threatening. A retrospective review of 12 patients who underwent surgery for congenital tracheal stenosis between 1996 and 2004 was conducted. The patients' median age was 3.6 months. All patients had diffuse tracheal stenosis involving 40-61% (median, 50%) of the length of the trachea, which was suspected to be associated with complete tracheal ring. Five patients had proximal bronchial stenosis also. Ten patients had associated cardiac anomalies. Three different techniques were performed; pericardial patch tracheoplasty (n=4), tracheal autograft tracheoplasty (n=6), and slide tracheoplasty (n=2). After pericardial tracheoplasty, there were 2 early and 2 late deaths. All patients survived after autograft and slide tracheoplasty except one who died of pneumonia one year after the autograft tracheoplasty. The duration of ventilator support was 6-40 days after autograft and 6-7 days after slide tracheoplasty. The duration of hospital stay was 13-266 days after autograft and 19-21 days after slide tracheoplasty. Repeated bronchoscopic examinations were required after pericardial and autograft tracheoplasty. These data demonstrate that pericardial patch tracheoplasty show poor results, whereas autograft or slide tracheoplasty gives excellent short- and long-term results.
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Affiliation(s)
- Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Congenital tracheal lesions are rare, but important, causes of morbidity in infants and children. Consequently, experience in their management is limited and dispersed. Given its small diameter, the juvenile trachea is obstructed easily by various natural causes, or following a surgical intervention. The diagnosis of a congenital, tracheal, obstructive anomaly is based on a high degree of suspicion in infants and children with respiratory distress accompanied by retraction. In this article, the authors discuss the various causes of these conditions, their diagnostic features, and the treatment possibilities.
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Affiliation(s)
- Kishore Sandu
- Department of Otorhinolaryngology, Centre Hospitalier Universitaire Vaudois, Lausanne 1011, Switzerland.
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Le Bret E, Roger G, Pezzettigotta S, Belli E, Roussin R, Serraf A, Garabédian EN. [Slide tracheoplasty in congenital tracheal stenosis]. ACTA ACUST UNITED AC 2007; 123:325-32. [PMID: 17202991 DOI: 10.1016/s0003-438x(06)76682-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Slide Tracheoplasty has progressively become the gold standard in the management of long-segment tracheal stenosis in children and infants. However, in certain situations this operation might become difficult and others techniques might be preferred. MATERIAL AND METHODS Five patients, 1 to 6 month old had surgery by our team, for complex tracheal stenosis between 2001 and 2005. Tracheal hypoplasia was considered complex because it was associated to either: an acquired critical stenosis, a cricoid stenosis, a bronchial stenosis, a tracheal bronchus or associated to oesophageal atresia and severe tracheomalacia. All of them have been treated by a modified slide tracheoplasty. RESULTS The postoperative status required an average of 15 days in ICU, including 8 days of ventilation. Two patients had laryngeal nerve injury. Medium term follow up (27 months) demonstrated no need for re-intervention, good potential growth and normal child activity. CONCLUSIONS Slide tracheoplasty can provide good results in certain cases of severe and complex tracheal hypoplasia in infants.
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Affiliation(s)
- E Le Bret
- Département des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, Université Paris XI, 133 avenue de la Résistance, 92350 Le Plessis Robinson, and Service d'ORL Pédiatrique, Hôpital d'Enfants Armant Trousseau, France.
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Beierlein W, Elliott MJ. Variations in the Technique of Slide Tracheoplasty to Repair Complex Forms of Long-Segment Congenital Tracheal Stenoses. Ann Thorac Surg 2006; 82:1540-2. [PMID: 16996982 DOI: 10.1016/j.athoracsur.2005.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 10/14/2005] [Accepted: 11/01/2005] [Indexed: 10/24/2022]
Abstract
Slide tracheoplasty has become the preferred technique for repair of long-segment congenital tracheal stenosis with complete tracheal rings. Complex morphological subtypes require technical modifications, which we present as follows.
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Affiliation(s)
- Wolfram Beierlein
- Cardiothoracic Unit, Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
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Le Bret E, Teissier N, Belli E, Sigal-Cinqualbre A, Couloignier V, Narcy P, Demontoux S, Gharbi N, Roussin R, Van Den Abbeele T, Serraf A. Slide tracheoplasty in the presence of tracheal bronchus in an infant. J Thorac Cardiovasc Surg 2006; 132:e15-6. [PMID: 16798291 DOI: 10.1016/j.jtcvs.2006.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 03/14/2006] [Accepted: 03/21/2006] [Indexed: 11/21/2022]
Affiliation(s)
- Emmanuel Le Bret
- Pediatric Cardio-Thoracic Department, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.
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Le Bret E, Garabédian EN, Teissier N, Belli E, Gharbi N, Bruniaux J, Roussin R, Sigal-Cinqualbre A, Serraf A. Slide cricotracheoplasty in an infant. J Thorac Cardiovasc Surg 2006; 132:179-80. [PMID: 16798331 DOI: 10.1016/j.jtcvs.2006.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 01/13/2006] [Indexed: 12/01/2022]
Affiliation(s)
- Emmanuel Le Bret
- Service des Cardiopathies Congénitales, Centre chirurgical Marie Lannelongue, Le Plessis Robinson, France.
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Abstract
Primary tumours of the trachea can be benign or malignant and account for fewer than 0.1% of tumours. However, they are a diagnostic and therapeutic challenge. Benign tumours are usually misdiagnosed as asthma or chronic lung disease, and can delay diagnosis for months or years. Because of their rapid growth and onset of haemoptysis, malignant tumours are often diagnosed earlier than benign tumours and patients thus often present with locally advanced disease. Inappropriate treatment is an equally frustrating issue. Modern techniques for tracheal surgery-laryngotracheal, tracheal, or carinal resection-combined with radiotherapy, can be offered curatively with low perioperative risks. Nevertheless, the low numbers of patients undergoing resection and the associated poor survival in epidemiological studies over the past two decades have shown that surgery is rarely considered outside referral centres, with radiotherapy or another form of local treatment (eg, endotracheal stents, debridement, brachytherapy) generally preferred. The liberal use of these other techniques should be avoided because surgery has the potential to cure all patients with benign and low-grade tumours and most patients with malignant primary tracheal tumours, and other techniques are usually palliative at best.
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Affiliation(s)
- Paolo Macchiarini
- Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, 170 Villaroel, E-30889 Barcelona.
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Rafay MA, Hajjar WM, Essa MA, Mahasin ZZ, Al-Kattan KM. Slide tracheoplasty for congenital tracheal stenosis with glottic stenosis. Asian Cardiovasc Thorac Ann 2004; 12:190-2. [PMID: 15353453 DOI: 10.1177/021849230401200302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 7-month-old child with respiratory distress was diagnosed to have full-length tracheal stenosis with glottic stenosis. Slide tracheoplasty and anterior cricoid split with stenting for glottic stenosis were successfully performed, and the child has completed 5 years of asymptomatic follow-up. This case widens the scope for slide tracheoplasty, and cricoid split with stenting is a feasible procedure for associated glottic stenosis.
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Affiliation(s)
- Mohammed A Rafay
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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ten Hallers EJO, Rakhorst G, Marres HAM, Jansen JA, van Kooten TG, Schutte HK, van Loon JP, van der Houwen EB, Verkerke GJ. Animal models for tracheal research. Biomaterials 2004; 25:1533-43. [PMID: 14697856 DOI: 10.1016/s0142-9612(03)00500-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tracheal research covers two main areas of interest: tracheal reconstruction and tracheal fixation. Tracheal reconstructions are aimed at rearranging or replacing parts of the tracheal tissue using implantation and transplantation techniques. The indications for tracheal reconstruction are numerous: obstructing tracheal tumors, trauma, post-intubation tissue reactions, etc. Although in the past years much progress has been made, none of the new developed techniques have resulted in clinical application at large scale. Tissue engineering is believed to be the technique to provide a solution for reconstruction of tracheal defects. Although developing functional tracheal tissue from different cultured cell types is still a challenge. Tracheal fixation research is relatively new in the field and concentrates on solving fixation-related problems for laryngectomized patients. In prosthetic voice rehabilitation tracheo-esophageal silicon rubber speech valves and tracheostoma valves are used. This is often accompanied by many complications. The animal models used for tracheal research vary widely and in most publications proper scientific arguments for animal selection are never mentioned. It showed that the choice on animal models is a multi-factorial process in which non-scientific arguments tend to play a key role. The aim of this study is to provide biomaterials scientists with information about tracheal research and the animal models used.
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Affiliation(s)
- E J O ten Hallers
- Faculty of Medicine, Department of BioMedical Engineering, University of Groningen, P.O. Box 196, Groningen, 9700, The Netherlands
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23
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Elliott M, Roebuck D, Noctor C, McLaren C, Hartley B, Mok Q, Dunne C, Pigott N, Patel C, Patel A, Wallis C. The management of congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 2003; 67 Suppl 1:S183-92. [PMID: 14662192 DOI: 10.1016/j.ijporl.2003.08.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper reviews current concepts and results in the management of congenital tracheal stenosis (CTS). Diagnostic options are considered and the requirements for successful management defined. Chief amongst these is a multi-disciplinary approach with individualised patient management. Severe long-segment CTS represents the biggest challenge to clinicians and the worst problems for affected families. Near-death episodes are frequent in affected infants and some cannot be ventilated and require ECMO. Associated cardiovascular anomalies are frequent. Patients require immediate resuscitation and transfer to a specialist unit. After careful assessment, accurate diagnosis and discussion, primary resection and end-to-end repair with a slide technique should always be the first option, with concomitant repair of associated cardiac anomalies. If this is impossible because of the severity of the lesion, some form of patch tracheoplasty will be indicated. Cardiopulmonary bypass is often required. Patches include pericardium, autograft trachea, carotid artery, cartilage, and allograft trachea. Mortality ranges from 0 to 30% in the literature, which largely comprises single-centre long-term experience. Recurrence is common and can be managed by stenting and tracheal homograft implantation. Long-term quality of life of survivors is little reported but seems good. Physiological data are lacking. To improve results, we suggest a treatment algorithm to rationalise care.
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Affiliation(s)
- Martin Elliott
- The Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
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24
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Antón-Pacheco JL, Cano I, García A, Martínez A, Cuadros J, Berchi FJ. Patterns of management of congenital tracheal stenosis. J Pediatr Surg 2003; 38:1452-8. [PMID: 14577067 DOI: 10.1016/s0022-3468(03)00495-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE Stenosing airway disease, including congenital and acquired lesions, is rare in the pediatric age group. Until recently, the outlook for patients with congenital tracheal stenosis (CTS) was dismal because medical management was the only way of treatment. Surgical and endoscopical techniques developed in the last years have improved the prognosis. This report reviews the short and long-term outcomes of a single-institution experience in the management of CTS in children, comparing different treatment modalities. METHODS From 1991 to 2002, 13 cases of CTS have been managed in the authors unit. Respiratory symptoms varied from mild stridor on exertion to severe distress. Bronchoscopy established the diagnosis in all cases. According to clinical and endoscopical features, patients have been classified into 3 groups. The following data have been studied in each case: sex, age at diagnosis and treatment, anatomic type, associated anomalies, treatment modality, complications, outcome, and time of follow-up. RESULTS Seven girls and 6 boys have been included in this study. Age at diagnosis ranged from 3 days to 7 years (median, 8 months), and 77% showed associated anomalies. Four patients presented mild or no symptoms and have been treated expectantly. The other 9 patients have been operated on because of persistent or severe symptomatology. The following procedures have been performed: costal cartilage tracheoplasty (n = 5), tracheal resection (n = 3), slide tracheoplasty (n = 2), endoscopical dilatation (n = 3), and laser resection (n = 1). Three patients required 2 or more procedures, and there were 3 early deaths, all after costal cartilage tracheoplasty. Overall mortality rate in the series is 23%. Follow-up is complete in all survivors (n = 10) ranging from 6 months to 10 years (mean, 4.7 years). CONCLUSIONS Selection of the type of treatment depends on the patient's clinical status and the anatomic pattern of the stenosis. In symptomatic cases of short-segment stenoses the authors prefer tracheal resection with end-to-end anastomosis; for long-segment stenoses, slide tracheoplasty is the procedure of choice.
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Affiliation(s)
- Juan L Antón-Pacheco
- Department of Pediatric Surgery and Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
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25
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Abstract
Pediatric tracheal surgery is uncommon, and few centers have enough experience to make meaningful conclusions about treatment. Short-segment congenital tracheal stenosis is treated by tracheal resection, whereas long-segment stenosis is treated by either augmentation tracheoplasty or slide tracheoplasty (the author's preferred approach). Tracheomalacia is treated most commonly by aortopexy. Postintubation tracheal stenosis is usually treated by tracheal (or laryngotracheal) resection.
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Affiliation(s)
- Cameron D Wright
- General Thoracic Surgical Unit, Department of Surgery, Blake 1570, Massachusetts General Hospital, 32 Fruit Street Boston, MA 02114, USA.
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26
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Han SJ, Kim YH, Kim MJ, Lee KY, Han A, Hwang EH. Slide cricotracheoplasty: a novel surgical technique for congenital cricotracheal stenosis. J Pediatr Surg 2002; 37:E36. [PMID: 12407566 DOI: 10.1053/jpsu.2002.36208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to introduce a new surgical technique for the correction of congenital cricotracheal stenosis. METHODS A 5-day-old girl presented with esophageal atresia and congenital cricotracheal stenosis. After successfully correcting her esophageal atresia, the authors chose to use a type of slide cricotracheoplasty, which was a modification of slide tracheoplasty and anterior cricoid split. RESULTS The postoperative period was remarkably uneventful except for minor subcutaneous emphysema, and the midterm results were excellent. CONCLUSIONS Slide cricotracheoplasty produced a good result and offered the same advantages as slide tracheoplasty. The authors believe that the described technique offers an efficient surgical procedure for the single-staged correction of congenital cricotracheal stenosis.
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Affiliation(s)
- Seok Joo Han
- Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea
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27
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Grillo HC, Wright CD, Vlahakes GJ, MacGillivray TE. Management of congenital tracheal stenosis by means of slide tracheoplasty or resection and reconstruction, with long-term follow-up of growth after slide tracheoplasty. J Thorac Cardiovasc Surg 2002. [DOI: 10.1053/jtc.2002.v123.p0145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Matúte JA, Romero R, Garcia-Casillas MA, de Agustìn JC, Marhuenda C, Berchi FJ, Vazquez J. Surgical approach to funnel-shaped congenital tracheal stenosis. J Pediatr Surg 2001; 36:320-3. [PMID: 11172425 DOI: 10.1053/jpsu.2001.20706] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to evaluate the results obtained by 2 different techniques of tracheoplasty in the treatment of long-segment, funnel-shaped congenital tracheal stenosis (CTS) in 2 tertiary paediatric hospitals. METHODS The clinical records of patients with long segment congenital tracheal stenosis during the period January 1990 to June 1999 were reviewed retrospectively. Age, gender, symptoms, imaging (x-ray, computed tomography, magnetic resonance imaging, or bronchography), endoscopic findings, associated anomalies, treatment, intubation time, postoperative treatment, intensive care unit stay, complications, hospital stay, evolution, and follow-up time were analyzed. Short congenital tracheal stenosis treated by resection and end-to-end anastomosis are not included. Results are given as mean +/- SEM. RESULTS Ten (7 boys, 4 girls) of 14 patients with CTS had a funnel-shaped CTS. Mean age at treatment was 9.7 +/- 4.8 months (range, 3 days to 4.7 years). All of the patients presented with CTS affecting the distal third of the trachea and 4 of them extension to 1 main stem bronchus. They were treated by 2 different types of tracheoplasty: anterior costal cartilage graft (ACGT, 6 patients) and slide tracheoplasty (ST, 4 patients). All the patients treated by ACGT failed: 4 died and 2 required further surgery for restenosis. Causes of death were acute respiratory failure during surgery (2 cases) and anastomotic dehiscence (2 cases). The patients treated with ST are asymptomatic and doing well. Mean postoperative intubation time of the ACGT group was 35 +/- 25 days (10 to 60 days), whereas in the ST group it was 14 +/- 12 days (0 to 51 days). Mean hospital stays were 292 +/- 271 days (21 to 563 days) and 24 +/- 13 days (7 to 63 days), respectively. Mean follow-up time is 28 +/- 14 months (3 to 94 months). CONCLUSIONS Surgery of long-segment congenital tracheal stenosis has a high failure and complication rate with vital implications in prognosis. Treatment should be done in a multidisciplinary basis by a highly trained and motivated team. Slide tracheoplasty seems to be the better option, although further multicentre studies should be conducted.
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Affiliation(s)
- J A Matúte
- Department of Pediatric Surgery, Hospital Infantil Gregorio Marañón, Madrid, Spain
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Garabédian EN, Le Bret E, Corré A, Roger G, Pineau E, Bourel P, Folliguet T, Vouhé P, Laborde F. Tracheal resection associated with slide tracheoplasty for long-segment congenital tracheal stenosis involving the carina. J Thorac Cardiovasc Surg 2001; 121:393-5. [PMID: 11174749 DOI: 10.1067/mtc.2001.109702] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- E N Garabédian
- Département d'ORL pédiatrique, Hôpital d'enfants Armand Trousseau, Université, Paris, France
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Macchiarini P, Candelier JJ, Coullin P, Guerra N, de Montpreville V, Dartevelle P, Duprez-Angioi K, Oriol R. Use of embryonic human trachea grown in nude mice to patch-repair congenital tracheal stenosis. Transplantation 2000; 70:1555-9. [PMID: 11152215 DOI: 10.1097/00007890-200012150-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long congenital tracheal stenosis is a life-threatening condition, and the available surgical treatments do not give satisfactory long-term results. METHODS Human embryonic tracheas were implanted in the abdominal cavities of nude mice until their differentiation was completed. These differentiated tracheas were used to patch-repair surgically induced tracheal stenosis in piglets. The human, mouse, or pig origin, of all the cells in the two successive xenotransplants in the nude mouse and the pig, was determined on tissue sections by in situ hybridization with species-specific DNA probes. RESULTS The transplanted pigs thrived and reached normal adulthood, irrespective of the administration of immunosuppressive treatment. The human tracheal tissue developed in nude mice conserved human structures, with the exception of feeding capillaries, which were of mouse origin. The tracheal patch in the adult healthy pigs comprised only pig cells organized into a fibrous scar, which was covered by normal pig epithelium. CONCLUSIONS Results suggest that human embryonic trachea grown in nude mice can be successfully used as patch tracheoplasty for long congenital tracheal stenosis without conventional immunosuppression.
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Affiliation(s)
- P Macchiarini
- Department of Thoracic and Vascular Surgery, Heidehaus Hospital Hannover Medical School, Germany
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Antón-Pacheco Sánchez JL, Cuadros García J, Villafruela Sanz M, García Hernández G, Comas Illas J, Berchi García FJ. [Treatment of congenital tracheal stenosis using a slide tracheoplasty]. Arch Bronconeumol 2000; 36:597-600. [PMID: 11149204 DOI: 10.1016/s0300-2896(15)30103-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Congenital tracheal stenosis (CTS) is a rare malformation that usually require corrective surgery. Resection and tracheal anastomosis is the treatment of choice when the stenosis is short. However, such an approach is not usually viable when the CTS is long, given that anastomotic pressure would be too great. New surgical techniques have allowed this serious airway malformation to be corrected satisfactorily. We report the case of a three-year-old boy with a long CTS (51% of the length of the trachea) treated with a new reconstructive technique called slide tracheoplasty. Outcome was excellent.
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Lipshutz GS, Jennings RW, Lopoo JB, Farmer D, Harrison MR, Albanese CT. Slide tracheoplasty for congenital tracheal stenosis: a case report. J Pediatr Surg 2000; 35:259-61. [PMID: 10693676 DOI: 10.1016/s0022-3468(00)90020-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE A variety of techniques have been used to manage pediatric congenital tracheal stenosis. The authors report the technique of slide tracheoplasty for a child with long congenital tracheal stenosis. METHODS A 2-year-old male presented with a history of stridor with feeding. Bronchoscopy findings showed 50% stenosis from complete cartilaginous rings, extending from 2.5 cm below the vocal cords to 2 cm above the carina. Through a neck incision, the trachea was exposed from the cricoid to both bronchi and transected at the midpoint of the stenosis. The upper trachea was split anteriorly to the area of stenosis just below the cricoid. The lower trachea was split posteriorly in the midline. Posterior dissection allowed sliding and anastomosis of both tracheal segments while the lateral vascular supply was left intact. A brace was placed to maintain cervical flexion, and the patient underwent extubation in the operating room. RESULTS He recovered without complication and was dis charged on postoperative day 4. CONCLUSION Slide tracheoplasty offers several advantages for tracheal reconstruction because it is performed with the native tracheal tissues, can be accomplished through a transverse collar incision, and can repair long stenoses without significant tracheal shortening.
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Affiliation(s)
- G S Lipshutz
- Department of Surgery, University of California, San Francisco 94143-0570, USA
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Muraji T, Satoh S, Tsugawa C, Moriuchi T, Yamaguchi M, Matamoros MA, Nishijima E, Suzuki T, Murata H. Slide tracheoplasty: a case report of successful concomitant reconstruction of extensive congenital tracheal stenosis and pulmonary artery sling. J Pediatr Surg 1998; 33:1658-9. [PMID: 9856889 DOI: 10.1016/s0022-3468(98)90603-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An 8-month-old infant presented with an extensive congenital tracheal stenosis with an aberrant left pulmonary artery. The patient was treated successfully by relocation of the left pulmonary artery and tracheal reconstruction with slide tracheoplasty. This patient is the first survivor cited in the literature after concomitant repair using slide tracheoplasty.
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Affiliation(s)
- T Muraji
- Department of Surgery, Kobe Childrens Hospital, Hyogo-ken, Japan
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Houël R, Serraf A, Macchiarini P, Bruniaux J, Planché C. Tracheoplasty in congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 1998; 44:31-8. [PMID: 9720677 DOI: 10.1016/s0165-5876(98)00033-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Congenital tracheal stenosis is an uncommon but life-threatening condition whose management is still debated. The rarity of this disease explains the lack of a standard management. Between 1986 and 1996, eight children younger than 1 year were referred to our Institution with a tracheal stenosis. The median age at operation was 3.15 months and the median weight was 4.5 kg. The diagnosis was made after an episode of respiratory distress in all but one and was confirmed by fiberoptic bronchoscopy. The median length of tracheal stenosis was 24.5 mm (Ranges: 4-30 mm). Only one patient was free from associated cardiovascular defect. Tracheal repair was performed under cardiopulmonary bypass in all. In three it was achieved by pericardial augmentation of the stenosed area, in four by resection and end to end anastomosis and in one by sliding tracheoplasty. Concomitant cardiac repair was performed in six. Two patients died after pericardial patch augmentation. In both, death was related to profound hypoxemia due to patch collapse. Two patients developed restenosis after resection and end to end anastomosis. They both had stent placement and one required reoperation and underwent a sliding tracheoplasty. At a median follow-up of 21 months (Ranges: 6-120) all the survivors are doing well and are free from respiratory symptoms. Bronchoscopic evaluation revealed in all a widely patent anastomosis without restenosis. In conclusion, tracheal stenosis in children remains a challenging lesion. Surgical technique, whether resection and end to end anastomosis or sliding tracheoplasty offer better results and should be discussed according to the length of the stenosis. Pericardial plasty should be used with caution.
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Affiliation(s)
- R Houël
- Department of Pediatric Cardiac Surgery (Pr Planché), Marie-Lannelongue Hospital, Le plessis Robinson, France
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